Cupisti Adamasco, D'Alessandro Claudia, Samoni Sara, Meola Mario, Egidi Maria Francesca
University of Pisa, Pisa, Italy,
J Nephrol. 2014 Oct;27(5):477-82. doi: 10.1007/s40620-014-0068-x. Epub 2014 Feb 28.
A definite epidemiological association exists between kidney stone disease and arterial hypertension, but the pathophysiological mechanisms are still not fully understood. Hypercalciuria or inflammation and oxidative stress have been proposed as possible links. However, there is more convincing evidence that the association between nephrolithiasis and hypertension may be considered as a part of the association between kidney stone disease, metabolic syndrome and atherosclerosis. From a clinical point of view, this association represents a crucial aspect of the clinical management of patients affected by kidney stone disease. In order to implement early prevention and treatment of cardiovascular and/or renal damage physicians should be encouraged to assess individual cardiovascular risk factors in any adult with kidney stones. Consequently, patients with kidney stones need a comprehensive approach rather than an intervention limited to the urinary tract and focused on stone resolution and recurrence prevention. It is time to view kidney stone disease as a systemic disorder, associated to or predictive of hypertension, chronic kidney disease, bone and cardiovascular damage. All these conditions negatively affect patient prognosis. This multi-systemic approach could increase the clinical impact of the kidney stone clinic.
肾结石疾病与动脉高血压之间存在明确的流行病学关联，但病理生理机制仍未完全明确。高钙尿症、炎症和氧化应激被认为是可能的联系。然而，有更具说服力的证据表明，肾结石与高血压之间的关联可能被视为肾结石疾病、代谢综合征和动脉粥样硬化之间关联的一部分。从临床角度来看，这种关联是肾结石疾病患者临床管理的关键方面。为了对心血管和/或肾脏损害进行早期预防和治疗，应鼓励医生评估任何患有肾结石的成年人的个体心血管危险因素。因此，肾结石患者需要一种综合方法，而不是仅限于尿路的干预措施，且干预重点应是结石溶解和预防复发。现在是时候将肾结石疾病视为一种系统性疾病了，它与高血压、慢性肾病、骨骼和心血管损害相关或具有预测性。所有这些情况都会对患者预后产生负面影响。这种多系统方法可以增加肾结石门诊的临床影响力。
